2016 THUNDERBIRD LACROSSE WINTER REGISTRATION
2016 THUNDERBIRD LACROSSE WINTER REGISTRATION www.ThunderbirdLacrosse.com NAME: _________________________________________________________________________ DATE OF BIRTH: _________________ AGE:__________ GRADE:__________________________ WHAT SCHOOL DO YOU ATTEND:__________________ HOME ADDRESS:_________________________________________________________________ ________________________________________________________________________________ HOME PHONE: ____________________________ PARENT’S NAMES: _______________________________________________________________ EMAIL ADDRESS PREFERRED:_____________________________________________________ 2ND EMAIL ADDRESS:______________________________________________________________ MOTHER’S CELL PHONE: _________________________ WORK: _________________________ FATHER’S CELL PHONE: __________________________ WORK: _________________________ US LACROSSE MEMBERSHIP NUMBER: _____________________________________________ EXPIRATION DATE:_________________________________ Players can register with US Lacrosse online at www.uslacrosse.org (annual fee = $25.00) Participation in Thunderbird Lacrosse requires US Lacrosse membership.
PARENT/GUARDIAN SIGNATURE_______________________________DATE____________ Registration Fees may be paid by Check or Credit Card by Phone Make Checks payable to “Thunderbird Lacrosse”, or call 202-445-6138 to pay by phone Individual Player - $140.00*; Team Registration - $1,250.00* (early registration discount)
Thunderbird Lacrosse of Georgia, Inc. 4555 Mansell Road, Suite 300 Alpharetta, GA 30022 678-696-0080
Thunderbird Lacrosse 2016 – 2017 Consent, Release & Indemnity Agreement We the undersigned, for and in consideration of providing the undersigned Player with the opportunity to participate in the Thunderbird Girls Lacrosse Program, do hereby unconditionally release and agree to indemnify and hold harmless the Thunderbird Lacrosse of Georgia, Inc. and any person, coach, volunteer or entity employed by or associated with any of them from any and all claims for personal injury, death, property damage or any type of claim or damage (including, but not limited to attorney’s fees and litigation expenses) resulting from or arising out of the undersigned Thunderbird Girls Lacrosse Program for the 2016 – 2017 season. We, the undersigned, hereby consent and grant the coaches or volunteers of Thunderbird Lacrosse of Georgia, Inc. with the express authority and discretion, but not the requirement, to provide any medical or emergency services needed by the undersigned Player during his participation in the sport of lacrosse with the undersigned parent being financially responsible for such services. The undersigned represents the Player is physically and psychologically able and prepared to participate in the sport of lacrosse, and understands and accepts the fact that sports, including lacrosse, and understands and accepts the fact that sports, including lacrosse, involve risks of injury or worse, which risks the undersigned understand and do hereby voluntarily and knowingly assume. Date__________________________ Players Name_____________________________________ Parents Name_____________________________________ Parents Signature__________________________________
PARENT/GUARDIAN SIGNATURE_______________________________DATE____________ Registration Fees may be paid by Check or Credit Card by Phone Make Checks payable to “Thunderbird Lacrosse”, or call 202-445-6138 to pay by phone Individual Player - $140.00*; Team Registration - $1,250.00* (early registration discount)
Thunderbird Lacrosse of Georgia, Inc. 4555 Mansell Road, Suite 300 Alpharetta, GA 30022 678-696-0080
Thunderbird Lacrosse 2016 – 2017 Consent, Release & Indemnity Agreement We the undersigned, for and in consideration of providing the undersigned Player with the opportunity to participate in the Thunderbird Girls Lacrosse Program, do hereby unconditionally release and agree to indemnify and hold harmless the Thunderbird Lacrosse of Georgia, Inc. and any person, coach, volunteer or entity employed by or associated with any of them from any and all claims for personal injury, death, property damage or any type of claim or damage (including, but not limited to attorney’s fees and litigation expenses) resulting from or arising out of the undersigned Thunderbird Girls Lacrosse Program for the 2016 – 2017 season. We, the undersigned, hereby consent and grant the coaches or volunteers of Thunderbird Lacrosse of Georgia, Inc. with the express authority and discretion, but not the requirement, to provide any medical or emergency services needed by the undersigned Player during his participation in the sport of lacrosse with the undersigned parent being financially responsible for such services. The undersigned represents the Player is physically and psychologically able and prepared to participate in the sport of lacrosse, and understands and accepts the fact that sports, including lacrosse, and understands and accepts the fact that sports, including lacrosse, involve risks of injury or worse, which risks the undersigned understand and do hereby voluntarily and knowingly assume. Date__________________________ Players Name_____________________________________ Parents Name_____________________________________ Parents Signature__________________________________
